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Physiological performance and inflammatory markers as indicators of complications after oesophageal cancer surgery

Powell, A. G. M. T., Eley, C., Abdelrahman, T., Coxon, A. H., Chin, C., Appadurai, I., Davies, R., Bailey, D. M. and Lewis, W. G. 2020. Physiological performance and inflammatory markers as indicators of complications after oesophageal cancer surgery. BJS Open 4 (5) , pp. 840-846. 10.1002/bjs5.50328

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Abstract

Background The extent to which physiological factors influence outcome following oesophageal cancer surgery is poorly understood. This study aimed to evaluate the extent to which cardiorespiratory fitness and selected metabolic factors predicted complications after surgery for carcinoma. Methods Two hundred and twenty‐five consecutive patients underwent preoperative cardiopulmonary exercise testing to determine peak oxygen uptake (urn:x-wiley:24749842:media:bjs550328:bjs550328-math-0001o2peak), anaerobic threshold and the ventilatory equivalent for carbon dioxide (urn:x-wiley:24749842:media:bjs550328:bjs550328-math-0002e/urn:x-wiley:24749842:media:bjs550328:bjs550328-math-0003co2). Cephalic venous blood was assayed for serum C‐reactive protein (CRP) and albumin levels, and a full blood count was done. The primary outcome measure was the Morbidity Severity Score (MSS). Results One hundred and ninety‐eight patients had anatomical resection. A high MSS (Clavien–Dindo grade III or above) was found in 48 patients (24·2 per cent) and was related to an increased CRP concentration (area under the receiver operating characteristic (ROC) curve (AUC) 0·62, P = 0·001) and lower urn:x-wiley:24749842:media:bjs550328:bjs550328-math-0004o2peak (AUC 0·36, P = 0·003). Dichotomization of CRP levels (above 10 mg/l) and urn:x-wiley:24749842:media:bjs550328:bjs550328-math-0005o2peak (below 18·6 ml per kg per min) yielded adjusted odds ratios (ORs) for a high MSS of 2·86 (P = 0·025) and 2·92 (P = 0·002) respectively. Compared with a cohort with a low Combined Inflammatory and Physiology Score (CIPS), the OR was 1·70 (95 per cent c.i. 0·85 to 3·39) for intermediate and 27·47 (3·12 to 241·69) for high CIPS (P < 0·001). Conclusion CRP and urn:x-wiley:24749842:media:bjs550328:bjs550328-math-0006o2peak were independently associated with major complications after potentially curative oesophagectomy for cancer. A composite risk score identified a group of patients with a high risk of developing complications.

Item Type: Article
Date Type: Publication
Status: Published
Schools: Medicine
Publisher: Wiley
ISSN: 2474-9842
Date of First Compliant Deposit: 18 August 2020
Date of Acceptance: 24 June 2020
Last Modified: 16 Oct 2020 10:15
URI: http://orca.cf.ac.uk/id/eprint/134281

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